Membership Application Form

I/We wish to join the Pan-Clan. Please send me my Welcome Pack including Membership Card and a back issue of PANtasia, the club magazine. My details are:

Rider's Name:
Partner's Name:
Address:
Post Code:		Phone number:
email address:
Bike:	ST1100 ST1300
Payment Method:	Internet Banking Cheque

Details of how to pay will be on the Confirmation page based on the selection above.

The membership year runs from June – May each year. Join in April or May to get the benefit of the extra month(s) subscription.

Join in:	Payment amount and renewal date:
November 2011 to March 2012	£17 Renewable in May 2012
April 2012	£30 Renewable in May 2013 - 14 months subscription
May 2012	£30 Renewable in May 2013 - 13 months subscription
June to October 2012	£30 Renewable in May 2013
These rates INCLUDE a £5 registration Fee. The renewal subscription is £25.00.
This information will be held on the club's database where it will only be used to keep you informed of club events by posting you the club magazine, PANtasia. The information will also be sent to your Area Rep who will only use the information to keep you up-to-date with club and local activites, usually by email. Tick this box if you do NOT want your information passed to your Area Rep where it will ONLY be used to keep you informed of Local and National events.

Membership Application Form

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